Associations of 24-hr Movement Behaviors With Cardiometabolic Risk Factors and Metabolic Syndrome in Adults Receiving Outpatient Rehabilitation: A Compositional Time-Use Analysis

Background: Research suggests associations between physical activity, sedentary behavior, sleep, and metabolic syndrome, but most has focused on healthy populations and individual behaviors. We investigated associations of 24-hr movement behavior compositions with cardiometabolic risk factors and metabolic syndrome in adults receiving rehabilitation for other health conditions. Method: This cross-sectional study assessed 24-hr movement behaviors using thigh-worn accelerometers and metabolic outcomes via blood analyses in 145 adults attending outpatient rehabilitation. Regression models tested associations of five 24-hr time-use behaviors (time in bed, sedentary time, standing, light-intensity stepping, and moderate- to vigorous-intensity stepping) with cardiometabolic risk factors and metabolic syndrome severity score (a cumulative measure of risk derived from metabolic risk factors). Results: Participants (64 [SD 12] years old; 52% women; 66% with metabolic syndrome, with 6 [SD 0.7] days of 24-hr data) spent 41% of a 24-hr day sedentary, 15% standing, 3% in light-intensity stepping, 2% in moderate- to vigorous-intensity stepping, and 38% in bed. Adjusted models indicated that a higher proportion of light-intensity stepping was associated with lower triglycerides, more time in bed was associated with a higher metabolic syndrome severity score, and more time stepping was associated with a lower metabolic syndrome severity score. There was no evidence of associations between the overall compositions and outcomes. Conclusion: The consistently observed small proportions of physical activity, with lack of variation between participants, may not be sufficient to counteract the impact of high sedentary time on metabolic outcomes in adults attending outpatient rehabilitation. Implications: Future research may focus on exploring ways to increase light-intensity stepping in sedentary older adults with various health conditions.